Date of Award



Department of Orthodontics

First Advisor

James Chen

First Committee Member

Heesoo Oh


Introduction: Socioeconomically disadvantaged children have limited access to orthodontic services not only because of their families’ competing needs for limited resources, but also because of the limited availability of orthodontists in their communities and a shortage of orthodontists who are willing to treat patients enrolled in Medicaid. We will systematically explore the hypothesis that an early interceptive treatment protocol using removable appliances provides the same treatment outcome but better cost-effectiveness than a traditional fixed-appliance protocol. Methods: Interim data on a prospective study with patients being treated either in private practice with rational fixed Phase I orthodontic treatment (n=11) or in a community clinic with removable interceptive orthodontic treatment (n=10). Initial and post treatment study models were acquired along with pretreatment PAR and clinical photos. PAR and ICON scores were assessed on all initial and final casts. Cost effective analyses were performed comparing the two treatment groups as well as comparing the removable group to no treatment. Sensitivity analyses were performed to assess the robustness of our data while manipulating certain treatment outcome variables. Results: For the fixed group the average PAR score at T2 was 7.6 with a 68% reduction from T1 to T2, while the ICON average score was 16.2 with a 67% reduction. In the removable group the average PAR score at T2 was 13.4 with a lesser reduction from T1 to T2 than the fixed group at 48% (p=0.20), while the ICON average score was 25.3 with a significantly lower reduction of 39% when compare to the fixed group (p=0.037). Cost effectiveness analyses showed that the removable appliance treatment protocol was cost effective when compared to no treatment but not cost effective when compared to 3 the traditional fixed Phase I treatment using the studies measured probabilities of success. Conclusion: The removable appliance protocol used at the Fruitvale community clinic can effectively reduce the severity of malocclusions. However, in order for this treatment to be cost effective when compared to a traditional fixed Phase I protocol it needs to demonstrate consistent clinical results and minimize the probability of “No Improvement”.